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We are happy to announce we have officially reopened!!

Please click here to read our new protocols

Vision Therapy
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We're located near the intersection of Bell Road and Highway 49 in North Auburn
Home » Contact Us » Patient Forms

Patient Forms

Developmental History

Please fill out for your child before their Visual Perception Evaluation

Developmental History – Printable PDF

Developmental History – Online

Neuro Eval Info and Questionnaire

Information about Neuro-Optometric Examinations, and a Questionnaire to complete before the exam.

NOTE: This form is ONLY for patients who have had a concussion, mild brain injury, stroke, or any form of neurological insult like toxicity. If you’re unsure, please contact our office for further instructions.

Neuro Packet – Printable PDF

Neuro Packet – Online

Student Interview

Please have your child fill out this form, in their own handwriting, prior to his/her Visual Perceptual Evaluation.

Student Interview – Printable PDF